Is anyone getting "Nurse generated PICC consent" following physician order? Our policy states "talking points" for our PICC nurse to review with patient/POA and then obtain consent. This is now being questioned. Apparently DOH states this consent (invasive procedure) must be obtained by physician or clinical practiioner. They've outlined this terminology which would exclude CRNI. Any input would be helpful.
See the Standard 12 Informed Consent in the 2011 Infusion Nurses Standards of Practice. 12.2 states this shall be obtained by the healthcare procider who will perform the procedure and shall include -----
There are 14 references provided. I have always obtained the informed consent for all procedures I have performed.
But as you will see in a search of other discussion of this topic on this forum, it might come down to how you define "informed consent". This is a process that begins with patient education and ends with the patients/or other legal representatives signature on a piece of paper. A physician who does not place PICCs is not the one to do all the education however if your state rules demand it, they may have to be the one to get the signature on a piece of paper. True informed consent is so much more than that piece of paper. You can and should be involved in that process and document all that you have taught the patient along with your assessment of their knowledge after that education.
Your talking points approach might be the problem. Again, see the standard for a list of what must be included in a complete informed consent process.
Also see the definition in the glossary of this same document. There is nothing in that definition about signing a piece of paper. DOH can not take away your rights and responsibilities to educate your patient about what is happening with their care.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Having a form ( in the patient's language ) that clearly explains the risks, benefits, and alternatives using understandable terminology that can be read by or to the patient and family goes a long way toward meeting this standard. Asking for and answering any questions they might have is also essential. Who obtains or witnesses the signature is less important than documenting you are meeting the criteria. It is nice when a Provider is the point person, but I agree with Lynn that the process needs to be done by someone who understands it, and can answer questions accurately and appropriately.
Daniel Juckette RN, CCRN, VA-BC
Just went thru this with Joint Commission... The JC says the "proceduralist" is responsible for discussing the risks and benefits of the procedure. I can tell you that my Drs don't know. Fall back on your accreditating body.
Kimberly DuBore, RN, BSN
PICC Chick and Imaging Nurse
We as the clinicians do the explaining to the patient and their family/SO; however, we do not witness the consent - generally the nursing staff will do that, but we are careful to ensure the patient and/or family understand the procedure and has all questions answered prior to placing the line.